Email _______________________________ Date_____________
Name _____________________________________________
Company __________________________________________
Mail Address _______________________________________
City _________________________State ____________Zip__________
Phone No. _________________________
Ship to if different than above, UPS needs physical
address
Name _____________________________________________
Company __________________________________________
Address ___________________________________________
City _________________________State ____________Zip__________
Phone No. _________________________
Check or Money
Order is preferred. C.O.D. not available.
Discover, VISA, MasterCard No.
_________________________________
Expiration Date _______ Card Code Numbers on Back ____________
Phone Number on Card Back
_____________________________
Name on Card ______________________________________
Catalog No.
Quantity
Description
Pounds
Price
Total
Total Pounds (round up to next full pound)
Total
UPSGround Shipping Cost: 80¢ per pound plus
$12 ______________ UPS insurance: Add $1
per each $100 value ______________ US Post OfficeShipping Cost:
$1.40 per pound plus
$12 ______________ US Post Office Insurance:$2.40
for
first $100, then $1.20
per $100
remaining
______________
Sub Total ______________
Add 7.7% sales tax on Sub
Total for Kansas
orders
______________ Total ______________
Print this page and mail or fax with
payment.
Shipping info
and policies Fax 785-364-5123